Intensive care patients; Brain damage; Coma; Vegetative state; Minimally conscious state; Locked-in syndrome; Brain death; Positron emission tomography; Functional magnetic resonance imaging; Intensivpatienten; Hirnschädigung; Koma
Abstract :
[en] Comatose, vegetative, minimally conscious or locked-in patients represent a problem in terms of diagnosis, prognosis, treatment and everyday management at the intensive care unit. The evaluation of possible cognitive functions in these patients is difficult because voluntary movements may be very small, inconsistent and easily exhausted. Functional neuroimaging cannot replace the clinical assessment of patients with altered states of consciousness. Nevertheless, it can describe objectively how deviant from normal the cerebral activity is and its regional distribution at rest and under various conditions of stimulation. The quantification of brain activity differentiates patients who sometimes only differ by a brief and incomplete blink of an eye. In the present paper, we will first try to define consciousness as it can be assessed at the patient's bedside. We then review the major clinical entities of altered states of consciousness encountered in the intensive care unit. Finally, we discuss the functional neuroanatomy of these conditions as assessed by positron emission tomography (PET) scanning. [de] Betreuung auf der Intensivstation dar. Am Patientenbett ist die Evaluation möglicher kognitiver Funktionen schwierig, weil willentliche Bewegungen möglicherweise sehr gering, unregelmäßig oder für die Patienten schnell erschöpfend sind. Funktionelle neurologische Bildgebungsverfahren können die klinische Einschätzung von Patienten mit veränderten Bewusstseinszuständen nicht ersetzen. Dennoch kann objektiv beschrieben werden, wie stark die zerebrale Aktivität und ihre regionale Verteilung in Ruhe und unter Stimulation vom Normalzustand abweichen. Durch Quantifizierung der Gehirnaktivität können Patienten differenziert werden, die sich manchmal nur durch ein kurzes und unvollständiges Blinzeln voneinander unterscheiden. Nach unserer Meinung werden Positronenemissionstomographie (PET) und die künftige Nutzung von functional magnetic resonance imaging (fMRI) unser Verständnis schwer hirngeschädigter Patienten substanziell erweitern.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Faymonville, Marie-Elisabeth ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Pantke, Karl-Heinz
Berré, Jacques
Sadzot, Bernard ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Ferring, Martine
De Tiège, Xavier
Mavroudakis, Nicolas
van Bogaert, Patrick
Lambermont, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Frais communs médecine
Damas, Pierre ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Franck, Georges ; Université de Liège - ULiège > Relations académiques et scientifiques (Médecine)
Lamy, Maurice ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Luxen, André ; Université de Liège - ULiège > Département de chimie (sciences) > Chimie organique de synthèse - Centre de recherches du cyclotron
Moonen, Gustave ; Université de Liège - ULiège > Département des sciences cliniques > Neurologie - Doyen de la Faculté de Médecine
Goldman, Serge
Maquet, Pierre ; Université de Liège - ULiège > Centre de recherches du cyclotron
Laureys, Steven ; Université de Liège - ULiège > Centre de recherches du cyclotron
Zerebrale Funktionen bei hirngeschädigten Patienten. Was bedeuten Koma, "vegetative state“, "minimally conscious state“, "Locked-in-Syndrom“ und Hirntod?
Alternative titles :
[en] Cerebral functions in brain-damaged patients. What is meant by coma, vegetative state, minimally conscious state, locked-in syndrome and brain death?
Publication date :
December 2004
Journal title :
Anaesthesist
ISSN :
0003-2417
eISSN :
1432-055X
Publisher :
Springer, New York, United States - New York
Volume :
53
Issue :
12
Pages :
1195-1202
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
The original publication is available at http://www.springerlink.com/content/4ak5gn16yumv2mb8/?p=8faa2a1e77854ab99d95a5de4c1330bfπ=1
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